If you know of or suspect health insurance fraud, please report it.
Patients and their medical insurance information can be exploited in various ways that result in increased costs and decreased confidence in the healthcare system. As part of our efforts to improve and protect the healthcare system, Blue KC is part of a Blues Plans network and nationwide campaign to share how physicians, healthcare providers and customers can help with healthcare fraud and detection.
What is Healthcare Fraud and Abuse?
Who Commits Healthcare Fraud and Abuse?
Report Fraud and Abuse
Healthcare fraud takes place when a provider or consumer intentionally submits (or causes someone else to submit) false or misleading information for use in determining the amount of healthcare benefits payable. Healthcare abuse is similar to healthcare fraud, but where intent cannot be established.
Some examples of provider healthcare fraud and abuse are:
Some examples of consumer healthcare fraud are:
Medical Identity Theft is a fast-growing, but little known, crime in which a thief uses a person's name and social security or health insurance number to get medical treatment, or charge insurance companies for phony services. As many as 500,000 Americans have had their medical information stolen, and victims can be left with huge bills for services they never received, along with legal, medical and insurance-fraud issues that can take years to untangle. Even more, experts say that anyone with insurance is a potential victim of Medical Identity Theft. We encourage you to follow these general guidelines to safeguard yourself from medical identify theft and preventable medical errors, and improve the quality of care you receive.
The Blue KC Special Investigations Unit (SIU) has been in continuous operation since 1986. The unit is staffed by experienced investigators, who together monitor claims from a wide range of provider specialties. The SIU also utilizes specialized fraud and abuse detection technology to identify unusual billing activities, then works to address potential issues quickly and in compliance with corporate policies and procedures.
The SIU has a number of goals, including:
While the vast majority of healthcare professionals and others involved in the healthcare system are honest and ethical, healthcare fraud and abuse continue to be serious issues in America today.
If you suspect that healthcare dollars are being paid improperly or as a result of false or misleading information provided to Blue KC, notify us by using the contact options listed below. You may also use these contact options to report suspicions or allegations of Fraud or Abuse anonymously.
Complete a Healthcare Fraud and Abuse Complaint Form
Email us at _SIU@BlueKC.com
Call our Hotline
816-395-3151 or 800-340-0119
Hotline for FEP Members
816-395-2870 or 800-337-8440